Shame and Attachment to Your Therapist

Two recent comments touched on strong emotions about the therapeutic relationship but on opposite sides of the same dilemma in psychotherapy. One person felt that she should become more attached to her therapist for her treatment to be effective, but was having trouble allowing that to happen due partly to shame. The other was horrified and ashamed to realize that she had become attached to her therapist. Other readers have expressed similar intense feelings of shame in relation to a therapist.

The key is understanding how our conscience can be pressed into service to shield us from possible pain. In recent years, perhaps since the 60s, the conscience or superego has almost disappeared from professional literature. On the other hand, I think it is one of the most important and useful concepts we have. I have devoted a whole chapter (Chapter 5) to the subject in How We Heal and Grow: The Power of Facing Your Feelings. I came to this view from working with trauma survivors and realizing that healing the intense feelings of the trauma was hard to get to, but once it happened, that work was done. In contrast, inappropriate feelings of low self-esteem and even guilt seemed to be much harder to heal and remained subject to relapse when something bad happened in my patient’s life. To me this meant we were dealing with two distinct healing mechanisms. To make a long story short, I eventually came to understand that distorted attitudes and values had been internalized into the conscience or superego and were producing negative judgments against the self at the same time that healthier values were working as they should.

Photo by Grey World, Flickr

Let me clarify. I have a very simple view of the conscience. It has two parts. One is a set of internalized templates of appropriate behavior. These consist of attitudes, values, ideals and prohibitions. According to Alan Schore, they start to appear around 18 months of age. The conscience begins to be functional by age three. Three year-olds really want to be “good.” What has not been well recognized is that values, positive and negative, continue to be internalized throughout life. Trauma is one time when negative values are most likely to be internalized. Most important, they are very hard to change. The obvious reason is that your conscience needs to resist the impulse of the minute in order to keep your ship steady over time.

The second part of the conscience is the “enforcement arm” It uses very specific forms of positive and negative reinforcement to influence behavior and keep us out of trouble. It rewards behavior consistent with our values with feelings of pride. It punishes our deviations with feelings of shame and guilt. These are very powerful feelings and strongly influence our behavior.

People whose early attachment experiences have caused pain and discomfort very often develop internalized values that say it is “bad” to trust or get close. When such values are in place, guess what we feel when we find ourselves getting close or trusting another person? Of course, we feel intense shame. Perhaps these values were internalized in the first place for a very good reason, to prevent repeated experiences of rejection or betrayal. On the other hand, in adult life, when we can chose those we trust and those we want to get close to, values formed long ago can prevent us from entering into healthy relationships.

There is another aspect to this problem. Imagine if one has spent a lifetime avoiding closeness or dependance. Do those needs disappear? Most likely not. To the contrary, they get very strong. The more they are suppressed, the stronger they get. Intense needs generate intense shame.

This is the situation expressed so often in comments to posts on Moments of Change. People who need to experience safe and healthy dependance and trust find themselves feeling terribly ashamed of their natural needs.

Trusting a therapist is essential for the work to go as far as it needs to. If you are guarded, then you are leaving your therapist with an incomplete picture of yourself. If your therapist is not trustworthy, then your progress may be limited and something needs to be done. Assuming the therapist is worthy of your trust, it may take time to work up to full trust, but it needs to happen. Dependency is also part of healthy relationships. We are interdependent. When you have an operation, you become completely dependent. We need to depend on others for things beyond our capacity. The complicated part is how we are dependent. Parents constantly make judgment calls about when to help and when not. There are times when tying a child’s shoe lace is the right thing to do and times when it is better to say, “You can do it.” These are truly judgment calls and cannot always be perfect.

Therapy is also a place where patient and therapist must make judgments about what emotional work the patient is ready for. It is possible for patient and therapist to collude to have the therapist cover areas where the patient should actually be doing the work for his or herself. Therapists have the same responsibility as parents not to allow this, but it is a good thing to talk about it together if there is any question. These are not always easy things to spot and working together is a good check on how you are dividing up the emotional work. For example, therapy is aimed at helping patients build their own real-life relationships. There might be a time when the therapist is the only person a patient is ready to trust or feel close to. On the other hand, a time will come when risking closeness with outsiders becomes possible and therefore necessary for growth. So the key question is, “Am I really able to do this for myself?” Of course your conscience will chime in (inappropriately) that you should be ready for anything, but that may not really be true and the challenge may truly be beyond your capacity.

If you would like to read more, click HERE to return to the main page where How We Heal and Grow is available.

16 Comments

This is incredibly clear and concise and makes so much sense. Thanks for making this offputting topic approachable. I am sending this to my therapist. I appreciate this clarification — in reading it, it almost gives the shame an acceptable place at the table, not something to just feel even more shame about.

Your writing on trust stood out for me as this has been a show stopper in therapy at the moment.

Trust, as I understand it, can happen in two ways. Either one can trust from one’s heart, one’s emotions; effectively trusting from the right brain. Or trust cognitively, with one’s understanding. Initially, everyone who goes to therapy starts off by trusting the therapist’s professional ability to help one get healing. Trust with the heart is difficult. I tend to linger in the realms of the intellect. Not sure if it all comes down to trust or even trust being earned.

In a way I see it as a positioning. To be positioned in the emotion or in the cognitive. Yes, or both, but I see it like an airplane that never flies in a straight line, but zig-zags to its destination. If healing is meant to happen emotionally then surely trust should also be in the arena of the emotion? How does one trust emotionally? Especially if it’s not in one’s nature to be emotionally attuned to self or positioned in this realm, so to speak. However this happens, I can only see trust happen little by little. For trust is either in part or in full. I don’t have an answer, but assume trust is a perpetual choice that always gets reassessed. Whether this trust be reassured, earned or not. It is a risk one takes. It involves the risk of being vulnerable, rejected and shamed.

On a different note. Marina Abromovich was once asked what is intimacy? She answered: “Complete trust”. This rings true. If one can’t trust completely, intimacy will be an issue.

A part of me wishes you were my therapist because you explain the complexities of therapy so clearly. The other part of me is saying I think my therapist has been saying the same thing about trust. I do feel shame often when I intentionally asked or sought out getting my needs met. When they are not met during these moments, shame and other feelings overwhelm all else. I feel so inadequate and ill equipt for relationships. I feel I may never get it right, or good enough. How can I move out of these feelings?

Dear Snow, I think the way to get relationships right is through experience. It might have to start with your therapist, but I hope might soon progress into outside relationships. This means allowing the level of trust and engagement to deepen and when misattunement happens, as it inevitably will, it is time to work it through in explicit words. There is much more to it, but the essence is the doing.

JS, I can understand experience will help. It is difficult to be vulnerable when shame seems to accompany intimacy. It is as if they are opposite sides of a magnet, simultaneously and hypocritically attracted to each other. Thank you for being available and blogging. I think my therapist was hurt I blog with you, but I feel this is me getting “experience”.
Snow

Since your last post on shame and attachment to therapists, I’ve been more conscience about how I’m feeling around this issue in general, and started to take small risks. At the same time, I’ve been re-evaluating my personal relationships with others as well as kind of jobs I’ve allowed myself to take in my life.

I think I’ve been avoiding and running away from good things all my life. Some years ago, I was looking for a new job. My therapist was surprised to learn that I was looking for a secretarial job while he thought I should be at least looking for a management position. Likewise, in my personal relationships, I tend to be more comfortable with unrewarding ones. This is not due to lack of attention from sensitive and empathic people. When people were good to me and shown me positive interests, I felt undeserved and guilty. A thought of I might worth something to someone scared me, and I couldn’t stand to let them become closer to me. I realize it now. I’ve been sabotaging myself because of my low self-esteem and guilt.

I don’t want to be afraid to be seen any more. I want to enjoy being valued, and I want to be present – sharing moments with others. So how do I let good things and healthy relationships in, and not fear self-worth? Would you mind elaborating on low self-esteem and guilt a little more?

Great writing again! 🙂 In my case and I guess in many other people’s case the lack of trust manifested in many different ways. No matter how much I loved my T or thought I trusted her, I still had overwhelming thoughts for many many months which after having been through them, tell me a lot about my incapability of trust. I made up endless stories and concepts about why she said what she said and of course believed all my stories. They perfectly made sense to me. I saw every little action of hers as a purposeful action, whereas as we worked most of them turned out to be either wrong or just totally misleading. After about 1,5 years I started to feel better and feel more trust from the heart as one of the commenters have put it. Learning to trust your therapist is learning to trust yourself. It is so beautiful that there is someone to be there with you and for you to be able to do this.

Mistrust of the therapist is very common when early life is difficult, but it is important to note that the exact thoughts about how the therapist does not seem trustworthy may be important living memories of untrustworthy things that happened in the past and those are always worth exploring if they haven’t been already. JS

“Mistrust of the therapist is very common when early life is difficult, but it is important to note that the exact thoughts about how the therapist does not seem trustworthy may be important living memories of untrustworthy things that happened in the past and those are always worth exploring if they haven’t been already. JS”

But what if the therapist is, in reality, untrustworthy? The client is being asked to trust someone they cannot really know, someone who is playing a role in exchange for payment. As someone wrote, there is a big difference between someone who IS trustworthy and someone who APPEARS trustworthy. And if the client cannot discern the difference, they are in a very very vulnerable and dangerous place, if in fact the therapist turns out to be, for example, taking care of their own needs.

Dear Adam, You will find woven throughout this blog, discussion and comments about therapists who are not trustworthy. While I can’t know exactly what happened, I’m sorry to hear about your painful experience. Sometimes the impact of a betrayal in therapy takes additional power from previous experiences. I hope your efforts to process what happened have taken the full complexity and personal meaning of the trauma into account. My desire to clarify and simplify our understanding of psychotherapy is partly in the hope of helping increase the competence of therapists. In the next few days, I will also be re-introducing the SPSE, Scarsdale Psychotherapy Self-Evaluation, a rating instrument intended to help clients evaluate their therapy irrespective of style or school.

I didn’t know that I had formed an attachment to my therapist until I had to broach the idea of leaving therapy (for reasons I won’t explain here). When I need to leave something, I do so in a linear way of thinking: what’s the next logical step.

1. Perhaps I need to leave therapy?
2. What loose ends do I need to tie up? (Do I have all of her insurance claims submitted)
3. I’ll need her new office address, as she’s about to move.
4. How do I go about communicating this to her (I’ve been with her for over a year, longest ever w/a therapist)…

And then it hit me and it struck me like a ton of bricks- I couldn’t just leave this time. It made me sad. It felt like a loss and I became emotional. I was confused. I don’t develop attachments; I can care (and I do very much) w/o being attached. How did I allow this to happen? How did I screw this up so badly?

The last three sessions have been very difficult and her advice was to “lean into” the feelings, but I can’t be one of those people who develop an attachment to my therapist. How weak is that of me? It’s not something I do. I can maintain relationships with that divider.

I’m at a loss for what to do. I’m damned if I do, damned if I don’t. She knew that I was starting to push her away and she said, “I would very much appreciate if you wouldn’t pull your avoidant bullsh-t with me.” She gives it back, just as much as I dish it out.

I’m not sure if I can go back this week. Or ever again. And I’ll feel heartbroken if I don’t. She has helped me and after years of different therapists, she’s the only one who’s stuck (for me).

I agree with the assessment: I’m horrified and ashamed I developed this damned attachment and I’m completely at a loss as to what to do.

Hi,
I came across your blog as I tried to find some thoughts on ending therapy. In my case I’m about to move therapists as the one provided is being replaced by someone else (the beauty of a change in govt contracts means her staying isn’t financially viable). It is not her choice or mine, just the way things are. Although she has tried to model that it’s ok to feel sad, I feel I’m hit twice over; once in that she’s going and the loss/grief that I have to endure and, worse still, then having to start with someone new. I don’t think anyone I talk to quite understands how difficult the latter is having been convinced to trust and give it a go in the first place in the face of overwhelming reasons not to.
I’ve tried not to get attached but it’s happened. I feel powerless and that no amount of trying to rationalise my feelings will help me cope with the emotional turmoil. The only way out is through but it hurts like hell.

My therapist and I tried friendship. Very briefly. In the end, she said she wasn’t comfortable after all…ethics, licensure, boundaries, etc., and that was it. Christmas Eve.
That is the very abridged version of course.
I’ve been reading here and watching Maté videos (her suggestion…lol).
I am bereft. Good thing I’m medicated via a psychiatrist.
I’m seeing a former therapist in a couple days who knows about a same sex attachment in the past. New healthcare provider is also pending, so we’ll see.
I don’t know why I didn’t attach to the former therapist in the same way, but thank goodness I didn’t.
I’ve been sober 28 years. I’m not tempted to drink, but now see that I’m isolated from others in recovery. Guess I’ll be a cliche in January meetings.
This is exhausting.
One thing I read above is about just feeling, without shame. Good reminder.
Thanks so mush for this blog.